Article At Glance:
- Discussing sex takes openness from both client and therapist.
- Look for signs a potential therapist is truly sex-positive.
- Therapists must self-educate about clients’ sexual identities/experiences.
- Healing comes through multiple modalities, not just talk therapy alone.
Last month some of our therapists sat down with Karen Yates, a Chicago based sex therapist and somatic educator, to talk about therapy and sex for a live recording of her podcast Wild & Sublime. On her podcast, Karen interviews experts on sexuality, intimacy, and relationships in order to explore sexuality in all its varied forms, dismantle sexual shame, and encourage us all to become freer in our sexual expression.
In the episode “How to Talk to a Therapist About Sex” (season 3, episode 16), Best Therapies clinicians, Tom Doctor, Blake Mackie, and Hannah Schwartz, share their insights on bringing conversations about sex into therapy. The crew not only considers how to bring up sex as a client, but also discusses the responsibilities of therapists in creating an open and affirming space to explore sex and sexuality. Today on the blog we will share some of our favorite learning moments from their conversation.
- Tom Doctor, LCSW: Tom is passionate about working with LGBTQIA+, consensually non-monogamous, and Kink/BDSM involved clients. Tom is dedicated to bringing an anti-oppressive lens to their therapy and has built their career around making conversations about sex easier and more productive.
- Blake Mackie, LCSW: Blake believes in a strengths-based, client-centered approach when working with clients on issues such as depression, anxiety, trauma, psychosis, and challenges related to gender and sexuality. As a therapist, Blake’s work combines his passion for mental health and his commitment to social justice.
- Hannah Schwartz, LPC: Hannah loves to work with LGBTQIA+ individuals, trauma survivors, people who use substances, kinky individuals, and poly individuals. Hannah brings a harm reduction lens to her work and believes in meeting clients where they are through her collaborative approach to therapy.
Our Favorite Moments from the Wild & Sublime podcast!
1) Bringing up sex can be difficult–for clients AND therapists!
HS: I just think in the beginning, in general, therapy is awkward when you first meet a therapist. Like, who is this stranger? Who is this person that I’m supposed to tell all my deep, dark secrets to? All the intrusive thoughts, all the bad shit that may have gone on, and all the good stuff? So, meeting a therapist–it’s weird! It’s awkward–like, who are you? And so it takes time to build that rapport and that trust. And then even with somebody I’ve been meeting with for years, in some ways, sex is seen as taboo or private—like, oh, I can’t let you in all the way.
TD: Despite sex being everywhere, it is not generally a topic that is often investigated in a meaningful way. I think often for clinicians early in their careers there is a want to be like, “Okay, I know that I need to talk about emotions.” And so we go to therapy, and we talk about emotions. And I’m going to talk about the emotions that are stressing me out and that’s the thing we’re going to do. And there’s sort of a shying away from other things, even though there’s like a million ways that we get emotions, one of them being sex and sexuality. Unless [sex] is explicitly brought up, many clinicians will be like, okay, cool–that’s like a private thing, though. That’s your private thing.
BM: Yes, sex is put in this special category of secretiveness, right? We can go into trauma in your childhood, and all these complicated things. But sex does feel, I think, like one of the most kind of personal and uncomfortable things to talk about. Hopefully the therapist is comfortable with that. If not, then you’re already at a disadvantage there. But even with a therapist that’s competent in that, not knowing how the client might feel, and knowing that there is so much stigma there, I think that makes it difficult to go there sometimes.
2) How can you tell if your therapist is sex positive and willing to talk about sex?
TD: A thing that I would normally look for is, is the clinician willing to language match with me? So if I talk about getting f*ck*d in the a*s by 12 dudes, is the clinician going to be like, “Oh, when you were having an*l intercourse with several gentleman…” That’s gonna be like, “Oh, wow, there is some discomfort here.” Like, this is a [therapist] that is trying to meet me and just not doing it.…A major piece of being a clinician is like, can we language match our clients? Can we engage with them and meet them where they are? For some folks that I know, they will go to a therapist, and in the first session, as like a feeling-out process, talk about blood play, talk about some of their more edgy experiences, in order to feel out–is this person going to be a good fit? Is this person going to be able to hang with me? Or am I going to be ostracized or seen differently based on the way that I show up to therapy? Because, there’s all sorts of studies that would indicate the therapeutic relationship is the single most important piece of effective therapy. And so, I know for some folks, they will just come in guns ablazin’, specifically for the reason that they want to test that right off the bat.
HS: I kind of even want to take it back even a step further, before the first session. I encourage people to interview potential therapists. See if they do like a 15, 20 minute phone or Zoom consultation. Because this is somebody who will be working for you….I’ve interviewed my own therapists, saying, can you match my energy? Can you understand my world? Even in this brief, 15-minute conversation–will I be safe with you?
BM: For me, I think the most important thing is really listening to your gut. How does this person make me feel? More than any specific thing they say, how do we feel in our body when we’re talking to this person? Do we feel safe? Do we feel comfortable? Do we feel like they aren’t judging us?
3) What responsibility do therapists have to educate themselves about their clients’ experiences?
HS: You know you can ask the client, “What’s that experience like for you?” But I think the biggest responsibility that a clinician has is supervision and self-education. Whether that’s going to training seminars, reaching out to trusted colleagues—and if the therapist does some self reflection and realizes I might not be able to work with this person, it’s their responsibility to refer out.
BM: I agree with Hannah, that if we’re noticing any of our own biases are getting in the way, or just a complete lack of have information, it’s the therapist’s responsibility to seek that out, and to find someone safe that they can talk through things with, so any of those biases aren’t showing up in front of the client.
TD: With folks of various marginalized identities, I think it’s really common any time that you have a therapist that doesn’t share identities with you, in order to get the care that you want or if you want to be cared for by someone who is really knowledgeable in that area, there is often a certain amount of like, “Well f*ck, I guess it’s on me to educate this person.” And that feels gross. I don’t love that feeling.
And so when I’m supervising someone or when I’m talking to clinicians, I will often say, if we are going to ask a client a clarifying question, it should be directed at that client specifically. It should not be, tell me what that practice means generally. So if somebody comes in and says, “Oh, I was in this impact scene, and this happened, and that happened, and that happened,” I may ask a question like, “Tell me about what is it about impact play for you that you get out of it?” I won’t be like, “Why do kinksters want to get hit?” And so, that may be a way that you can do that work in-session with the client specifically, and then afterwards be like, What the f*ck is this—like, why would anyone want to do this? I don’t get it.
Let me check my own bias outside of session. And let me talk to colleagues—all the things that Blake and Hannah talked about. But I think, how do we get to the meaning for the client specifically, and then we can build the knowledge base on the back end.
If somebody comes in and says, “Oh, I’m queer,” I know queer means f*cking 1,000 things! And so I’m not going to ask the client to explain what queer means for all people. I am going to say, “What does [queer] mean to you?” Or if somebody says, Oh, I’m in a 24/7, D/S relationship with my nesting partner, I’m going to be like, “Okay, tell me about how that relationship affects you. Tell me about the dynamic that y’all are in.” Because that is actually a meaningful question about this client that is sitting in the chair right now. So the client is educating the clinician about themselves; they are not educating about the entire community.
Additional Read: Dear Postmates: Bottoms Can Eat Whatever They Want
4) How can therapy help us talk about sex?
BM: Cognitive Behavioral Therapy, or CBT, is one of the most common types of therapy that you’ll see out there. And the general idea with that is that if we want to change our feelings around something, we kind of have two ways to approach that–either with our thoughts—that’s the cognitive piece—or with our actions, the behavioral piece. Maybe we’re not feeling great about our sex life. So we might spend some time thinking about the narrative in our head, the beliefs that we have, and seeing if we can challenge any of those so that we do feel better. Or, again, we might look at some of our actions and ask, “What are some different coping skills I can use? Or different ways I can connect with people.” And that can change how we feel, too.
HS: Harm reduction, that’s my thing. You know, we are going to do what we want to do. But I want to make sure that we’re safe about it, and getting the most pleasure and the most safety out of it. Not just the physical safety, but the emotional safety. Is this somebody I trust? Is this somebody that I feel safe with? Harm reduction can be anything from getting vaccinated, wearing a mask, to wearing your seatbelt, to using lube, lots of lube if you don’t have a condom available. It could also be just talking to your partner about what you feel safe doing and what you don’t feel safe doing.
TD: I can talk a little bit about DBT or ACT, third wave behaviorism, which is a lot about mindfulness and attention. So let’s say that somebody struggles with, well, “I have anxiety with sex.” So what we would do there is ask, “How do we attend to what’s happening?” So, we stay grounded in our body, feel all of our self, and be able to recognize anxiety is going to happen.
And when anxiety happens, we can tolerate that and it can move through us. That anxiety does not need to control us. We can have anxiety, be present, and we’ll let it sit in the passenger seat while I’m driving. There’s way more that goes into third-wave behaviorism. There’s like, millions of skills we can do to manage the anxiety. There are a ton of other things. But generally speaking, the idea is that, how do we let distress not steer the ship? And instead build more intentionality and a more active ability to do the things that we want to do.
5) How else can we explore healing, especially related to sexual shame?
BM: I think it’s a great question, to not limit ourselves to just talk therapy. That there are somatic therapists and other somatic workers that are focusing more on the body and how that affects the way we feel, rather than starting with our thoughts. There are also different types of coaches. And I think to not leave out physical health and medical professionals because sometimes things are over medicalized so we don’t want to go too far that way, but there are a lot of resources that can be helpful to address physical health problems that may affect our sexuality. To address our mental health potentially through medication, if that’s the right fit for us. So to make sure we’re really looking at all of our options.
TD: There are a lot of ways that talk therapy can dig into the meanings of things. It can dig into a lot of the underlying mental health-type symptoms that are associated with sexual issues. And often, there may be physiological things going on; there may be a whole host of other areas that need to be addressed as well.
And so that can look like pelvic floor physical therapy. That can look like hormones; that can look like a whole wide variety of medications and things like that. It can also look like being in a community. It is so often that I will see people that come in with such great shame as their main presenting issue. And what they really need is not to sit alone in a room with one other person. What they need is to be held by the community. And so community is a type of treatment in my mind. There’s sort of this predominant white medical model of talk therapy that we go alone into a quiet room, and we sit with just the two of us, and that’s how you get to tell your deepest, darkest secrets. And often, it is actually in very non-white, non-medicalized settings that the most healing happens.
If I see a couple that is coming in and wants to talk about sex, what we’ll talk about before we get there is, “What does pleasure look like?” Like non-sexual pleasure. That is a question that I ask all the time. Often, that means doing some investigation that has nothing to do with therapy. What does play look like for you? Doing those types of investigations, I think, can be as therapeutic if not more therapeutic than a lot of individual one-on-one sessions. And so thinking about, how do we diversify healing? Or how do we diversify support beyond just one person? Because you can’t rely on, “Well, I go to therapy once a week, so therefore I’m going to be all better now.” It’s a lot more than that. And there’s a lot more diversity in interventions that you can be doing.
HS: One of my favorite quotes comes from Dr. Judith Herman. She wrote the book Trauma and Recovery. That’s one of my personal favorite books, both as a clinician, but also as a trauma survivor myself. She says that healing takes place in the community. And it really does. You don’t have to heal alone. You don’t have to do it alone. You don’t have to face it alone.
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To listen to the entire conversation with our Best Therapies crew, check out this full episode (s.3, ep.16) of Wild & Sublime available wherever you listen to your podcasts. You can also access a full transcript of the episode on the Wild & Sublime website.
Talking about sex can be fabulous and healing. You are allowed to bring sex up in therapy! If you are interested in exploring your sexual identities in therapy, reach out today!
